We used a cross-sectional survey to measure knowledge and preparedness related to utilization of environmental health shelter assessments among environmental health program directors or their designees (N = 56) who were identified on websites of state and territorial public health agencies. We developed and e-mailed a secure online survey tool (Qualtrics, a survey platform from FIU [Qualtrics, Provo, UT]) to study participants from May to August 2013. Participation was voluntary.

The self-administered questionnaire consisted of 15 questions in 5 domains: knowledge of and familiarity with shelter assessments, procedures and training, utilization of assessment tools, participation in planning and exercises, and feedback from survey respondents. Using IBM SPSS Statistics for Windows (version 21.0) for analysis (IBM Corp, Armonk, NY), we stratified by jurisdiction type and population size in millions (small, <1; medium, 1–4.9; large, 5–10; and mega, >10) and reported data in aggregate. We used descriptive statistics and Fisher’s exact test, with significance level at P < 0.05.

Of 56 eligible jurisdictions (49 states, 6 territories, and District of Columbia), 55 (98%) responded. Although no statistically significant results were found, jurisdictions overall reported high levels of knowledge of and familiarity with environmental health shelter assessments (92% of states and 100% of territories; Table 1). Small, medium, large, and mega-size jurisdictions reported knowledge of methods at 100%, 81%, 100%, and 100%, respectively.

Measures of familiarity with the information collected by assessment tools indicated that 87% of states and 80% of territories knew of the content of the tools. Small and mega-size jurisdictions were more familiar with information collected by the tools (91% and 100%, respectively). Knowledge of available environmental health shelter assessment tools was similar in both states and territories (77% vs 80%, respectively). Mega-size jurisdictions were found to be most knowledgeable about the tools (86%).

In the domain of preparedness for assessments, 79% of states and 83% of territories already used environmental health shelter assessments or were considering using them during future disasters. However, only 41% of states and 60% of territories reported receiving formal training in these methods. Although medium and large jurisdictions reported the highest levels of training (53% and 43%, respectively), only 53% of states and 50% of territories reported having formal operational procedures. Mega-size jurisdictions were less likely (29%) to have operational procedures than were large jurisdictions (64%). States and territories participated in disaster planning with partners (96% and 83%, respectively) and in disaster drills (88% and 83%, respectively). Most jurisdictions reported collaborating frequently with emergency management (96%) and the ARC (88%), and similarly for participating in exercises and drills with shelter partners (Figure 1).

Although states and territorial jurisdictions exhibited high levels of knowledge of and familiarity with environmental health shelter assessment methods, they still lacked ways to plan and operationalize shelter assessments during actual events. As an example, training and availability of shelter assessment procedures were observed to be low despite knowing that formal training and guidance for standard operating procedures are essential when deploying personnel under hazardous conditions. Also, standard shelter assessment procedures may be useful when working with external teams deploying through mutual or interstate agreements for disaster assistance and who may not be familiar with state or local procedures. Planning and operationalizing continue to be problematic despite efforts to improve systems for monitoring safety, services, and accommodations for persons with disabilities and those with functional and access needs by shelter services agencies.⁶

Because the survey was conducted at state and territorial levels, results may not reflect knowledge and preparedness at jurisdictional levels for cities, counties, or tribes, an important limitation because preparedness ideally occurs at all levels. Also, no clear national standards currently exist for environmental health assessment methods for shelter facilities, particularly in domestic settings. As a result, survey respondents might have misinterpreted terminology in the absence of common language or standards. Additionally, because responses were completely anonymous, assessing the respondents’ levels of experience or knowledge in environmental health shelter operations was not possible. However, our interactions with representatives from targeted jurisdictions allowed for appropriate feedback between the survey team and individual respondents. These extra actions ensured that the appropriate programs from the jurisdictions answered survey questions.

Our survey showed that preparedness trended positively. For example, most public health agencies appeared to be engaged in disaster planning and in participating in disaster drills and exercises with key partners. Acknowledgement of collaborations with established preparedness partners reflected the extent to which jurisdictions were committed to working with appropriate groups on shelter issues.

Because the public health sector leads disease and injury prevention efforts, having the operational capability and knowledge about these tools and methods to carry out these assessments is paramount for ensuring health and safety. Information from the results of disaster shelter assessments eventually could be used by mass care agencies as lessons learned, for training, and for developing specific guidance for different facilities to be used as shelters. Also, such information may provide the basis to evaluate the usefulness of these assessments in reducing morbidity and mortality in disaster shelter settings.

Environmental health shelter assessments are necessary to ensure the well-being of shelter occupants. Although environmental health shelter assessments are being used or considered, limited operational procedures hamper the ability of jurisdictions to effectively monitor shelter occupants. The public health sector, through its environmental health disaster response component, may ensure that assessment methods are incorporated as part of disaster response plans and procedures.